and Procedure Name:
Assessment and Initial Assessment Plan
4123-18-02; O.A.C. 4123-18-04; O.A.C. 4123-18-05
Kroninger, Chief of Medical Operations (Signature on file)
vocational rehabilitation policies, procedures, directives and memos
regarding initial assessments and initial assessment plans that predate the
effective date of this policy and procedure.
purpose of this policy is to ensure that a thorough initial assessment is
completed, including an initial assessment report and an assessment plan, when
policy applies to the:
disability management coordinators (DMCs);
care organization (MCO) staff involved in the coordination and management of
the vocational rehabilitation program; and
rehabilitation case managers (VRCMs) assigned by the MCO.
“Vocational Rehabilitation Definitions” in Chapter 4 of the MCO Policy
the policy of BWC that a thorough initial assessment will be conducted to
develop information and make recommendations to best serve the vocational needs
of the injured worker (IW).
1. To begin the initial
assessment phase, the VRCM shall contact the IW, the employer of record (EOR),
the physician of record (POR), the MCO and the DMC as provided in section
V.A.2-7, below. The VRCM may contact other people, as needed, that may provide
information related to the IW’s vocational needs.
a. The VRCM shall use all
contacts as a means of establishing a good working relationship that will aid
in the sharing of information and generally contribute to the IW’s successful
b. The VRCM shall ensure
that a proper authorization to release information is signed by the IW before
contacting the POR or any other provider.
c. The VRCM shall
document the time and date of each contact or attempted contact, the name of
the person contacted and the information received.
d. If, for any reason, a
required contact cannot be made (e.g., the EOR is out of business), the VRCM
shall clearly document the circumstances.
2. IW Contact – The VRCM
shall contact the IW within five (5) days of case assignment to schedule a
face-to-face initial interview. The VRCM shall gather the following information
and/or documents, if not already in the vocational documents, during this
interview (not an exhaustive list):
a. The IW’s hard copy
signature on the Rehabilitation Agreement (RH-1) acknowledging the IW’s
interest in vocational rehabilitation services;
b. Any medication usage,
prescribed or over-the-counter, frequency, dose and prescribing source;
c. Demographics (e.g.,
age, marital status, number of dependents, transportation issues);
e. Employment history (e.g.,
previous employment, job descriptions, reasons for leaving any prior
employment, union affiliations, military service);
f. Legal considerations (e.g.,
arrests, convictions, pending legal matters, non-citizen work status);
g. Medical concerns (e.g.,
abilities and limitations, unrelated medical or mental conditions, medical
disincentives (e.g., other financial benefits, other household income);
i. BWC Information (e.g.,
any previous claims, pending hearings); and
rehabilitation participation information (e.g., any previous vocational
rehabilitation including participation through other agencies).
3. Employer Contact
a. The VRCM shall,
whenever reasonably possible, visit the EOR or current employer’s worksite and
meet with the employer representative responsible for decisions regarding the
IW’s work status.
b. If a visit to the
employer is not reasonably possible, the VRCM shall make telephone contact.
c. The VRCM shall:
i. View and/or obtain a
detailed description of the work environment and job tasks performed by the IW
in order to determine if job modifications or alternative jobs may be available
to the IW;
ii. Discuss opportunities
for transitional work, RTW and/or other services with the employer
iii. Obtain information
about the IW’s work strengths.
4. POR Contact – The POR
shall be contacted, preferably in person.
a. The VRCM shall obtain
from the POR any documentation of:
i. The IW’s current
physical restrictions related to the allowed conditions;
ii. Current medications;
iii. Any needed prescription
for plan services.
b. The VRCM shall
discuss with the POR:
i. The IW’s medication
usage and specifically how this may impact the IW’s ability to perform specific
work tasks (e.g., operate machinery, drive);
ii. The IW’s restrictions
as they relate to the IW’s targeted job goal, using the job description or job
iii. The RTW options
available through the employer, including transitional work or other early RTW
iv. The IW’s ability to
participate in vocational rehabilitation services.
5. MCO Contact – The
VRCM shall contact the MCO to:
a. Obtain any recent
information received in the claim, especially any recent treatment requests and
b. Obtain feedback
regarding vocational rehabilitation services for the IW;
c. Obtain assistance
with gathering information from medical providers or the EOR, if needed; and
d. Staff current
strategy and recommendations.
6. DMC Contact – The
VRCM shall contact the DMC to:
a. Obtain any
information from the source claim or other claims, if necessary;
b. Obtain feedback
regarding vocational rehabilitation services for the IW;
c. Obtain any wage or
compensation information; and
d. Staff current
strategy and recommendations.
7. Attorney of Record
(AOR) Contact – The VRCM shall contact the AOR, if applicable, to:
a. Update the AOR on the
status of the initial assessment and recommendations;
b. Provide contact
c. Obtain AOR input; and
d. Enlist AOR assistance
with the IW, if necessary.
B. Complexity Factors:
Throughout the initial assessment phase, the VRCM shall begin identifying the
barriers and issues that create complexity in the case and noting these issues
on the Complexity Factors Reporting Form.
C. The Initial
1. Job Retention: The
VRCM is not required to complete an initial assessment report for job retention
services. The VRCM will proceed directly to a job retention plan (See the Job
Retention Plan Development and Implementation policy and procedure for
2. Except for job
retention services, the VRCM shall, within twenty-one (21) days of an
assignment, complete and submit to the MCO and the DMC an initial assessment
report using the Vocational Rehabilitation Initial Assessment Report (RH-42).
The report shall:
a. Summarize and
document the current vocational factors identified by the VRCM;
b. Identify vocational
barriers and strengths;
c. Identify additional
vocational questions, if any; and
d. Include a
i. Case closure; or
ii. Development of an
assessment plan to answer any identified questions and/or obtain additional
iii. Development of a
comprehensive vocational plan.
3. The MCO shall ensure
that the initial assessment report is provided on the current form and
submitted within 21 days of assignment.
4. If the report cannot
be completed within the 21-day timeframe, the VRCM shall submit to the MCO a
written justification for the delay, the current status and the projected
submission date for the report.
5. The MCO shall confirm
a. The initial
assessment report is reasonably based and that any subjective inferences are
substantiated with an objective behavioral description;
authorizations for the release of information were signed by the IW before the
VRCM contacted the POR and any other providers;
c. The VRCM submits the
initial assessment report before any plan services are authorized or delivered;
d. The Rehabilitation
Agreement (RH-1) and the authorization for release of information are
submitted no later than the submission of the initial assessment report.
D. Assessment Plan
1. The VRCM, DMC and MCO
shall staff any recommendation for an assessment plan.
2. Within 28 days of
assignment and upon agreement of the DMC and MCO, the VRCM shall develop and
submit the assessment plan, using the BWC form Vocational Rehabilitation
Assessment Plan (RH-43).
3. The VRCM shall ensure
all sections of the RH-43 are complete.
4. The VRCM shall:
a. Describe in detail
each service needed;
b. The rationale for
that service; and
c. The specific
questions to be answered by the service, as applicable.
5. The VRCM may include
in the assessment plan, as appropriate, the following reimbursable services and
activities (not an exhaustive list):
b. Evaluation of
functional and physical capacity;
d. Evaluation by a
physical medicine and rehabilitation physician;
f. Work conditioning
g. Vocational screening;
i. Career counseling;
k. Pre-test for GED;
l. Job analysis;
m. Ergonomic study;
n. Transferable skills
analysis (this may be conducted by the VRCM during the initial assessment);
o. Labor market survey;
rehabilitation case management for assessment and plan development
q. Travel; and
r. Other services as
authorized by the MCO.
6. The following are not
appropriate services for an assessment plan:
a. Employment services;
b. Work adjustment;
c. Actual training;
f. Job modifications;
g. The provision of
tools and equipment.
7. The DMC shall
authorize any of the following special assessment plan types prior to the
beginning of services (See the Special Vocational Plan Types policy and
procedure for further information):
a. Plans developed by a
vocational rehabilitation case management intern - The DMC shall be
notified of the assignment of an intern at the time of assignment or transfer.
b. Extension of
reimbursable service guidelines - The DMC shall enter a claim note
indicating approval or denial of a service that exceeds the service code limit
or exceeds the fee schedule.
c. Plans requiring
- The DMC shall be responsible for arranging and authorizing interpreter
services at critical junctures in the rehabilitation case, as necessary. See
the Interpreter Services policy and procedure for additional
d. Plans with services
paid “by report” (plans that include service codes that have no established
fees for the identified service) See the Provider Billing and Reimbursement
Manual for information on “by report” services.
8. The VRCM shall design
the assessment plan to be completed within 28 days.
9. The MCO and DMC shall
review the assessment plan and, if in agreement, the VRCM shall proceed with
10. If unusual
circumstances exist and the VRCM determines that additional assessments are
a. The VRCM shall submit
an amended assessment plan with justification for the additional services to
b. The MCO shall consult
with the DMC and approve or disapprove the amended assessment plan.
11. Signature Requirements
a. On an RH-43 (both the
original assessment plan and an amended assessment plan), the MCO shall require
a hard copy signature from the:
ii. MCO; and
iii. The IW within thirty
b. When the VRCM
initially receives verbal approval from the IW, the VRCM shall:
i. Initial and date the
appropriate “Plan of service approval” section, which serves to attest the verbal
approval was received from the IW awaiting the approval of the MCO; and
ii. Within 30 days of the
assessment plan start date, obtain and submit the IW’s hard copy signature to
the MCO and DMC.
c. The MCO shall not
accept an email- generated (i.e., typed) signature as a hard copy signature.
The MCO shall accept a scanned document sent via fax or email which reflects a
hard copy signature.
E. Living Maintenance
1. The DMC shall evaluate
and facilitate, when appropriate, payment of LM to the IW during the IW’s
participation in an assessment plan.
2. LM shall start on the
first day of the IW’s participation in the assessment plan and continue
throughout the period the IW is participating in the assessment plan.
3. The IW may continue
to receive LM for up to 14 days following completion of the assessment plan if
a comprehensive vocational rehabilitation plan is being developed.
4. For further
information on LM, refer to the Living Maintenance Compensation policy
1. Within seven days of
the IW’s completion of active services in an assessment plan, the VRCM shall
complete a written employability recommendation to the MCO. (This step occurs
during the time allotted on the assessment plan for comprehensive plan
2. The employability
recommendation shall summarize and integrate results from all the assessments
completed and outline vocational rehabilitation service options including:
a. The type of
b. The provider; and
c. Recommendations as to
whether the IW is a viable candidate at this time for participation in a
comprehensive vocational rehabilitation plan for purposes of RTW.
i. If the VRCM
determines that the IW is not a viable candidate and therefore not feasible for
vocational rehabilitation services, the MCO shall follow the procedures for
case closure (See the Vocational Rehabilitation Case Closure policy and
ii. If the VRCM
determines the IW is a viable candidate, the VRCM shall outline the service
options and staff the recommendations, preferably via telephone, with the MCO
and the DMC.
G. Reopened Cases
1. Cases closed during
or after the assessment plan may only be reopened with justification of
significant changes in the IW’s circumstances.
2. If a comprehensive
vocational rehabilitation plan is reopened within two months of closure due to
a rescinded closure or claim transfer, another initial assessment is not